A fire started in the hospital room of a patient using oxygen, quickly
rupturing the oxygen hoses attached to the piped oxygen wall outlets. The free-flowing
oxygen then intensified the fire, which rapidly involved most of the flammable objects in
the room. Copious amounts of smoke were forced out into the hall and throughout the
patient floor, necessitating the evacuation of many patients. When the firefighters
arrived, they shut off the oxygen to the room, which reduced the intensity of the fire and
enabled them to extinguish it.

Discussion

At least 10 hospital fires are reported each year. Many of these involve
oxygen enrichment from supplemental oxygen sources and result in patient injury or,
occasionally, death. Reducing the amount of oxygen reaching the fire directly affects the
fire's severity, the damage it causes, and the hazards it poses to patients and staff.

Fire requires oxygen to burn. Fires occurring in normal ambient
atmosphere—21% oxygen concentration—can be severe. However, fires occurring in
oxygen-enriched atmospheres (OEAs)—those above 23.5% oxygen concentration—are
larger, more intense, faster burning, and harder to extinguish; many materials that do not
burn in room air can burn in an OEA. Regardless of the oxygen concentration, any fire can
be slowed, lessened, or extinguished by removing oxygen from the area.

In hospitals, fire-fighting training programs stress closing windows and
shutting doors to exclude oxygen from a burning room. However, when respiratory therapy
equipment is in use, the only practical means of stopping the flow of piped oxygen,
nitrous oxide, or medical compressed air (all of which enable a fire to continue to burn)
into a patient room is by closing the pipeline zone valves.

Because zone valves typically control gas flow to several rooms, closing a
valve may affect patients in more than one room, although residual pressure in the
pipeline allows a short time before gas flow stops completely. Each zone valve must be
labeled with the area it controls (e.g., "Oxygen Valve: Controls Rooms 901 through
906"). If a fire occurs in a room in which oxygen, nitrous oxide, or medical
compressed air is in use, the zone valves controlling that room must be closed, and
affected patients requiring respiratory support must be immediately assisted. Failure to
close the zone valves risks intensifying and spreading the fire and smoke, placing more
lives at risk.

According to the Joint Commission on Accreditation of Healthcare
Organizations (JCAHO), every hospital must have a plan for dealing with fire emergencies.
This plan must account for the various hazardous actions, such as closing zone valves,
that have to be risked to deal with a fire. The plan should be taught to all hospital
staff, with periodic drills to reinforce the training.

The core of a fire plan involves the following steps, abbreviated by the
acronym RACE:

R

escue patients in the immediate area of the
fire. The person discovering the fire should perform the rescue if possible.

A

lert other personnel to the fire so that they
can assist. The discoverer should also let others know of a fire by yelling
"Fire in room 119!" while rescuing the occupants. Other personnel
hearing the alert should relay the information to the facility switchboard
or other alarm system.

C

ontain the fire. Shut the door after rescuing
the occupants to slow the spread of smoke and flame. Close fire doors. If
oxygen and/or medical compressed air is in use in the room, shut off the
zone valve controlling those gases to that room, and immediately assist all
affected patients.

E

vacuate other patients and personnel in the
areas around the fire. Facility personnel trained in fire emergency
procedures should respond to the initial alarm to assist in evacuating
patients to safe areas.

Depending on the facility's layout and staffing, certain RACE tasks (e.g.,
alerting the switchboard, shutting fire doors, closing zone valves) should be preassigned.
Amid the chaos of a fire, such tasks are not easy to remember or carry out. Training and
drilling can help hospital personnel learn and remember these emergency duties. JCAHO
requires appropriate education, training, and quarterly drilling for all personnel in all
elements of the fire safety plan (see PL.2.3.2, Accreditation Manual for Hospitals,
JCAHO, 1994).

Each facility should develop a customized plan that includes
prepositioning emergency supplies to support and transport patients during evacuation.
Regulators, manual resuscitators, masks, hoses, carts, oxygen cylinders, blankets, and
other necessary equipment should be readily available near patient areas. These supplies
should be regularly inspected and maintained in readiness. Hospital personnel should also
be trained in the use of this equipment.

Recommendations

Develop and maintain a plan to deal with fire
emergencies. This plan should include operation of medical gas and vacuum
system zone valves.

Train and drill all hospital staff in execution of
this plan.

Establish and maintain emergency supplies for
patient evacuation. These supplies should enable respiratory support of
patients during transport from the affected area to a safe haven.

Ensure that all medical gas and vacuum system zone valves are
functional, correctly labeled, and included in a routine inspection program. (Refer to the
Inspection and Preventive Maintenance [IPM] Procedure, "Medical Gas and Vacuum
Systems," in Health Devices 23[1-2], Jan-Feb 1994.)

For Further Information

A detailed discussion of the type of incident described in this report can
be found in Summary Fire Investigation Report—Hospital Fire, Brooklyn New York,
September 1, 1993, which is available from the Department Secretary for Fire
Investigation, National Fire Protection Association (NFPA), 1 Batterymarch Park, Quincy MA
02269-9101.

For additional information on planning for fire emergencies, see Section
C-8.3, Suggested Fire Response, Respiratory Therapy, in Standard for Health Care
Facilities (ANSI/NFPA 99, An American National Standard), and "The Patient Is on
Fire!" in Health Devices 21(1), Jan 1992.